9 July 2007
Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physican who knows you and cares about you.
Dr. Warren
When "attacked," he throws his toys on the ground, screams, clenches his fists and collapses on the floor crying. Attempts to soothe him are hit and miss. Sometimes, he reacts positively by burying his head in our shoulders. Other times, he pushes us away and prefers the floor. He stops almost as quickly as he started.
He does throw temper tantrums, but they are much different than what I am describing here. Those usually occur when he gets frustrated and can be predicted by watching him play and noticing his frustration level with a toy increase. These too, however, are more frequent and violent than any other child his age we know. He is teething, but even that pain is evidenced by his holding of his cheek and calming after Orajel is put on his gums.
I've done some research, but can find nothing that describes these symptoms in children so young. The closest I have come is A.D.D. in pre-schoolers, but none of my research mentioned it diagnosed as early as 15 months. As you can see, we are distraught over this situation and search for an answer to alleviate whatever anguish my son feels so quickly and frequently.
Thanks in advance for your help.
-PF
Dear PF: The diagnosis of A.D.D. cannot be made in a 15 month old because such young children do not have much of an attention span to begin with. A.D.D. is probably not all one disorder since some children only experience attentional problems which affect their school work, others are hyperactive, and some have major behavioral problems.
Features of A.D.D. can be seen as part of other disorders. The diagnosis of A.D.D. can only legitimately be made when the child has no other neurological or emotional condition causing his symptoms. Developmental disorders including PDD (pervasive developmental disorder - autism) can be seen in children with apparently normal or superior intelligence. I cannot tell from your description what condition, if any, your child might have, but an evaluation by a pediatric neurologist is in order.
Sincerely,
Dr. Warren
-MH
Dear MH: Most bed wetting is not caused by any disorder of the urinary tract. Of course, all children who wet their beds should have a urinalysis and culture done to rule out any pathology, but the majority of bed wetters have rarely been dry since infancy. The wetting occurs during sleep. Many, but not all, bed wetters are very deep sleepers, but even those that are not deep sleepers do not awaken until or after their bladders empty.
While most children are dry at night by 9 years of age, your son is not alone. There is still a high likelihood that as he matures the wetting problem will resolve; however, bed wetting may be so damaging to an older child's self esteem that it is usually a good idea to obtain treatment. Treatment may include medication or an alarm system. For additional information read my article about Bed Wetting.
Sincerely,
Dr. Warren
-Mr. & Mrs. L
Dear Mr. & Mrs. L: Breast tissue in girls under 2 years of age is not at all unusual and does not require that Mom be nursing. As long as there is no progressive breast growth or other signs of puberty such as growth acceleration or pubic hair it is not necessary to investigate the cause. It is not at all unusual to see a few small ovarian cysts (< 9 mm in size).
I cannot predict whether or not your daughter may have polycystic ovary disease when she is older, but her current situation is unrelated to the disorder. The only thing necessary to be sure nothing important is being missed is for your pediatrician to monitor your daughter's growth and observe for any signs of puberty.
Sincerely,
Dr. Warren
Thank you.
-Michelle
Dear Michelle: Teething may sometimes cause coughing because the child may cough on excess saliva in the throat, but I would be reluctant to suggest that teething can cause significant cold symptoms for two months without a break. On the other hand, your daughter is not running fever, has had a normal exam twice, and had a normal chest x-ray, so I have no reason to think there is anything more serious. Other possibilities to consider for persistent coughs include allergies, asthma, and in the case of severe coughing which comes in spasms, whooping cough. If it ia asthma, at some point your doctor should hear wheezing. If he is unsure he could do a therapeutic trial of albuterol to see if there is any response.
If the Pediacare works, I see no harm in giving it when you feel it is needed; however, you should not just give it every night as a matter of course. If she is doing well, you need to try a night without medication to see if she still needs it. Cough medicine does not cure anything. It only provides symptom relief.
Sincerely,
Dr. Warren
Note to Readers: That was my answer in November 2000. A recent study not only questioned the safety of cold medicines for infants [There were some infant deaths related to cold medicines. Dosing may have been an issue.], but also concluded that there was no evidence that these medications worked in infants. As I stated, these medicines do not cure colds. At best they may provide some symptomatic relief, but there is a price to pay in potential side effects like irritability. Now there is the additonal question of safety with no clear evidence of benefit. My advice: use great caution and as little medicine as possible for symptoms relief in infants! The study of cold medicine safety did not mention any brands, so theses comments are NOT directed at the brand mentioned in this question.
They say he should grow out of it. When does it end? What else could we be doing?
I look forward to a response.
-AG
Dear AG: I am not familiar with Tavegyl or Becotide spray. Since I cannot find any listing for them, I'm guessing that you're writing from a country outside the USA. Unfortunately the differences in prescription drugs available in other countries makes it difficult to comment on the best choices for treatment. There are many medications for management of asthma, but none cures asthma. If your son's symptoms are not well controlled by his current medications you must have regular follow up with his pediatrician so that his medications can be adjusted.
For a complete discussion of asthma read my 5 part series on asthma starting with What is Asthma?.
Unfortunately, there is no guaranteed age at which asthma will get better. Many children with asthma after the age of 3 improve after puberty, but for some it may be a lifelong illness. The course is variable from patient to patient so treatment must be individualized base on the patient's symptoms and response to treatment.
Sincerely,
Dr. Warren
-T
Dear T: If your daughter had stopped breathing for no reason at all, I could understand your anxiety that it might happen again, but it didn't just happen. Your daughter had severe croup which was causing respiratory obstruction. At some point this resulted in her not getting adequate oxygen, and as she could not continue the struggle to breathe she suffered a respiratory arrest. Even with croup this is a rare event. Of course, if she has croup again she should be treated aggressively, but there is no reason for you to worry that she will just stop breathing in the normal course of events.
Sincerely,
Dr. Warren
-JB
Dear JB: The term growing pains refers to leg pains which are common in healthy active children. They are not caused by growing. They are muscle spasms which occur at the end of a busy day. They generally occur at rest and often occur during the night waking the child from sleep. They can be distinguished from more worrisome causes of pain because they do not cause a limp and do not occur during activity or interfere with activity. If your daughter's leg pains do not fit the description of growing pains, she should be evaluated by her doctor.
Sincerely,
Dr. Warren
He has no fever. His appetite is good. He's reasonably active (bike riding, soccer, playing with friends) on the days he doesn't miss school. (I won't let him play with friends or play soccer if he's missed school.)
Does this sound like a medical problem or is he playing mom? When the school nurse called today I told her to keep him at school but to call if he's in the clinic complaining again. I'm at my wits end. Should I take him to our doctor?
Thank you for your response.
Sincerely,
-Jean
Dear Jean: Unless you have prior experience or some other good reason to think that your son is "playing Mom," you have to assume that your son's symptoms represent bonafide illness. Strep throat may cause sore throat and abdominal pain. If your son has not seen a doctor for these symptoms, he should.
Sincerely,
Dr. Warren
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